保乳术中数字化三维成像切缘评定

乳腺癌患者部分乳房切除术中切缘评定能够发现阳性切缘，并且立即切除邻近组织获得阴性切缘。

3月14日，美国乳腺外科医师学会和肿瘤外科学会《肿瘤外科学报》在线发表德克萨斯大学MD安德森癌症中心、克利夫兰医学中心、俄亥俄州立大学的研究报告，比较了数字化三维成像与标准化二维成像对于阳性切缘的检出能力。

该单中心研究于11月～9月对德克萨斯大学MD安德森癌症中心部分乳房切除术中大体标本和切片进行标准化二维成像，由乳腺放射科医师进行复核，并由乳腺病理医师进行总体评定，根据结果指导外科医师切除临近组织。前瞻获取大体标本的数字化三维成像，并由乳腺放射科医师进行回顾复核。阳性切缘定义为肿瘤墨染。

结果，98例患者共进行了99次部分乳房切除术，其中乳腺病理医师确认阳性切缘19个，标准化二维成像与数字化三维成像相比：

未检出：3个比5个

灵敏度：84%比74%（P>0.05）

特异度：78%比91%（P<0.05）

阳性预测值：11%比21.5%

阴性预测值：99%比99%

根据标准化二维成像指导切除邻近组织，其中6例最终病理确认切缘阳性，标准化二维成像未发现其中3例，数字化三维成像未发现其中2例。这些再次手术患者最终病理未见其他恶性肿瘤或仅局灶导管原位癌。

因此，该研究结果表明，数字化三维成像对于检测乳腺癌患者部分乳房切除术阳性切缘是一种准确的方法，效果与需要花费大量人力的术中标准化二维成像相似。

Ann Surg Oncol. Mar 14. [Epub ahead of print]

Digital Breast Tomosynthesis for Intraoperative Margin Assessment during Breast-Conserving Surgery.

Park KU, Kuerer HM, Rauch GM, Leung JWT, Sahin AA, Wei W, Li Y, Black DM.

University of Texas MD Anderson Cancer Center, Houston, USA; The Cleveland Clinic, Cleveland, USA; The Ohio State University, Columbus, USA.

BACKGROUND: Intraoperative margin assessment for breast cancer patients undergoing segmental mastectomy (SM) enables identification of positive margins, with immediate excision of additional tissue to obtain negative margins.

OBJECTIVE: The aim of this study was to determine the ability of digital breast tomosynthesis (DBT) to detect positive margins compared with an institution"s standard extensive processing (SEP).

METHODS: SM specimens underwent intraoperative SEP with two-dimensional (2D) imaging of the intact and sliced specimen, with review by a breast radiologist and gross assessment by a breast pathologist. Findings guided the surgeon to excise additional tissue. DBT images of intact specimens were prospectively obtained and retrospectively reviewed by a breast radiologist. A positive margin was defined as tumor at ink.

RESULTS: Ninety-eight patients underwent 99 SMs. With SEP, 14 (14%) SM specimens had 19 positive margins. SEP did not detect 3 of the 19 positive margins, for a sensitivity of 84%, specificity of 78%, positive predictive value (PPV) of 11%, and negative predictive value (NPV) of 99%. Moreover, DBT did not detect 5 of the 19 positive margins, for a sensitivity of 74% (p>0.05), specificity of 91% (p<0.05), PPV of 21.5%, and NPV of 99%. With SEP guidance to excise additional tissue, six cases had final positive margins, with SEP not identifying three of these cases and DBT not identifying two. Pathology from the second surgery of these patients showed either no additional malignancy or only focal ductal carcinoma in situ.

CONCLUSIONS: DBT is an accurate method for detecting positive margins in breast cancer patients undergoing SM, performing similar to institutional labor-intensive, intraoperative standard processing.

PMID: 30877499

DOI: 10.1245/s10434-019-07226-w

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